Abstract

Background

Infectious disease surveillance is a primary public health function in resource-limited
settings. In 2003, an electronic disease surveillance system (Alerta) was established
in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment
(NMRCD). Many challenges arose during the implementation process, and a variety of
solutions were applied. The purpose of this paper is to identify and discuss these
issues.

Methods

This is a retrospective description of the Alerta implementation. After a thoughtful
evaluation according to the Centers for Disease Control and Prevention (CDC) guidelines,
the main challenges to implementation were identified and solutions were devised in
the context of a resource-limited setting, Peru.

Results

After four years of operation, we have identified a number of challenges in implementing
and operating this electronic disease surveillance system. These can be divided into
the following categories: (1) issues with personnel and stakeholders; (2) issues with
resources in a developing setting; (3) issues with processes involved in the collection
of data and operation of the system; and (4) issues with organization at the central
hub. Some of the challenges are unique to resource-limited settings, but many are
applicable for any surveillance system. For each of these challenges, we developed
feasible solutions that are discussed.

Conclusion

There are many challenges to overcome when implementing an electronic disease surveillance
system, not only related to technology issues. A comprehensive approach is required
for success, including: technical support, personnel management, effective training,
and cultural sensitivity in order to assure the effective deployment of an electronic
disease surveillance system.